Placement of a ventriculoperitoneal (VP) shunt for hydrocephalus is the most common procedure performed by pediatric neurosurgeons. Shunts are the mainstay of treatment for hydrocephalus, but they have a high failure rate; the initial shunt in a pediatric patient has a 30% to 40% failure rate within a year. Failures require admission to the hospital and repeat surgery, and they are associated with a small risk of death (1%-2%). Decreasing the risk of shunt failure is an important goal for patients and neurosurgeons. Neurosurgeons insert VP shunts into the brain’s lateral ventricle at 1 of 2 entry sites on the head, anterior or posterior; the entry site is usually determined at the surgeon’s discretion. There are conflicting reports in the literature about which entry site is best. However, the quality of the evidence in these reports is low, and more rigorous studies are needed to guide neurosurgeons and patients in this potentially important treatment decision.
